HomeMy WebLinkAbout3700-3710 S Raitt St - Misc. Permit (57)a oAPPLICATION AND
PLUMBING PERMIT
(TYPEWRITE OB PBINT IN INK)
CITY OF SANTA ANA
206 W. 4th Street
667-273a h,,"
APPLICANT FILL IN AREA BELOW
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STATE/ZIP
2-,G
PHONE
NG
CITY Tao,"-;
q 5.00 ,9
10.00
NO.EACH TOTALE lndustrial E Commerdd
each plumbing fixture/trap
Dental Unit or Medical Gases
15.00
30.00
5.00
5.00
SEWER
1st 100'+Conn.
Ea. Add'l Conn.
Ea. Add'l 100'or Fraction
Private Sewage Disp. System
PIPING
GAS SERVICE 1 to 4 Outlets 5.00
Ea. Add'l Outlet 1.00
Bepair or Replace Gas Piping 5.00
Ornar-tu0rrar Dadraf bn
I hereby ertirm that I am exempt ,rom tlp Contraclor's Lrcens Law lor lhe rollowing roagon (Sec.
7@.l.5, Busrnes and Prol6srons Code. Any city or county which requr16 a pormit to conslruct.
alter. improve, demolish. or repaar any slructure. pflor lo its isuance. ds reguiroslhe applicant
lor such p€rmil lo tile a signsd stelemsnl lhal he is licensed pursuanl to lhe pIovisiom ot lho
Conlractor's License Law (Cheptor 9 (commsncing wilh Seclion 7@O) ol Oivision 3 ot the
Busines and Prol6siss Codo) or thal he is sxampt thorstrom and lhe baci8 lor tha allegod
exemplion Any violetion ol Secton 7O3l 5 by any applicant lor 8 pormil sbiets lhe spplic8nl lo
a civil p€nalty ol nol mofe lhen live hundr€d dollaB (S@)
E S*tion zOae l, as ownerol tho property. or myemployeswilhwsgG s lhersolocomp€n-
salion. wrll do the mrk, 8nd th6 structuE is not antonded or olldod loi sale.
E S*tion 70448 l. as owffi o, lhe properly. am €xclusavely contracting with licenrod
contracioG to construct lho proitrl
Oate Owrer (Srg )
100.00
5.00
Conlrmlon lraa Only
10.00
ffffilTL",2 a"uuir,-;L7*-o7a7
PHONE
8.00
Water Heater - Electric or Gas
Rain Whter Piping (buried) Ea. 100'
Gas Service
Water Soltner
Vvater Piping Ea. 100'
4.00
Alt. or Repair ol Drainage - Vent Piping 10.00STATE/ZIP
?63eo Larvn Sprinkler 6.00
10.00Rain System - Per Drain
lnd. Waste lnterceptor
Jod Traps 5.00
I horaby allirm that I am licens€d under the proyasions ol Chapts 3 ol the
No
Code. and my licen3o rs in lull force and ettel
Deck Drain System - Per Drain 3.00
Repair/Alt. Drainage or Vent 10.00
5.00 s
1.00
Vacuum Breakers 1-5
Over 5
5.00 5
10.00
10.00
subiecl to the Workar's Compensation Laws ol
l5$c. To APellcil:
ll atter makrng lhrs Ceflricale ol Exemptron. you should become subr*t lo the Worker's Compen-
salron provrsrons ol lhe Labor Code. you must torthwrlh comply wrlh such provrsrons or this
permrl shall be demed revoked
ComFrulbn O*lJtlbn
of Workar's
Oate
ths of
(srg )
VeralEd By
any manner so s to
Applicsnl (Sig.)
ot consenl to
the City
this permit is issusd. I shall notomployany
pensatron lnsu.ance. Certiti€d copy
I h€reby alfirm thal I have
Oate
Exprres
Date
(minimum 20.00)
Backflow Device 2" or Less
Water Service Ea. 1@'
Over 2"
Subtotal
Penalty Fee (when applicable)
Violation Fee
Plan Check 650/o of subtotal
Receipt Pc# $
Chec* (Adjustment)
(50.00)
lssuance Fee
TOTAL PERMIT FEE
ErDkdo.l
This pormil shall srpira by limilation 6nd become null and void i, the wo* euthorir€d by this
pormit is not commenced wilhin 180 dsys trom the dals o, thi3 permit or il work authorizsd by thig
p€rmit is suslmded or abandonod al any lime rlttr th€ worl is commonc€d tor I poriod ol ,|E0
days. A nil lsmil 3hall be oblranod tiBlab€torc 3uch wort can bo
AtDlicanl or Agent
I corlity lhal I hsve reed thrs and slete that tha above I agre to
and state laws relating to6oply with all
of lhis city to sntersuthorized
pu.pos6.
DATE 5'/
10.00
LOING
No (sig.))b >23- s7PERMIT ISSUEO 8Y (Sig.)
1-4121
Orslnbul I lnspector Copy 2 File 3 Finance Copy 4 copy
cs-61 1
FIXTURES
8.00
(minimum $3!,00) -4)-
l^l/* o,u-
Contrector (Sig
t o
PLUMBING INSPECTION RECORDS
Remarkt
Ground Work (Soil)
Ground Work (Water)
Water Service (Ground)
Gas Service and Underground
Lawn Sprinklers
Wasle lnterceptor
Pool Traps
Sewer
Rool Drains
Water H€alers
Water Soltner
Rental or Medical Gasss
}-
Rough Plumbing
Final Plumbing O
Temporary Gas Service
Notes 4/6,/u hr-*;-@
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O!t.lnrpoctor Approval
(8lOn.tu.c)
lktu
2/te/n 21, /4rtl
ilil,.2/- p.fr
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